Patellofemoral Pain Syndrome | Treatment and Prevention – Runner’s World

Patellofemoral pain syndrome (PFPS) got its nickname as “runner’s knee” for an obvious and very unfortunate reason: It’s most common among runners.

In some cases, the stress of running causes irritation where the kneecap (patella) rests on the thigh bone (the femur). The resulting pain can be sharp and sudden or dull and chronic, and it may disappear while you’re running, only to return again afterward, according to Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City and creator of Runner’s World’s workout.

Patellofemoral Pain Syndrome Symptoms

PFPS can affect one or both knees, and it strikes mostly younger, recreational runners and twice as many women as men, according to the British Journal of Sports Medicine. This is because women tend to have wider hips, resulting in a greater angling of the thigh bone to the knee, which puts the kneecap under more stress.

Patellofemoral pain syndrome symptoms include tenderness behind or around the patella (kneecap), usually toward the center. You may feel pain toward the back of your knee, and either a sense of cracking or that the knee is giving out. Steps, hills, and uneven terrain can aggravate the issue.

Common Causes of Patellofemoral Pain Syndrome

Pinpointing a single cause of runner’s knee is difficult. Runner’s knee could be a biomechanical problem—the patella may be larger on the outside than it is on the inside, it may sit too high in the femoral groove, or it may dislocate easily.

Worn cartilage in the knee joint that reduces shock absorption, highly-arched or flat feet, or knees that turn in or out excessively and pull the patella sideways are among other biomechanical reasons runner’s knee happens, according to Metzl.

If it’s not biomechanical, poorly-conditioned quadriceps and tight hamstrings or calves might be to blame. Weak quads aren’t able to support the patella, which leads the patella to track out of alignment, and inflexible hamstrings can put added pressure on the knee. Just the repetitive force of a normal running stride alone can be enough to provoke an attack of runner’s knee.

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Patellofemoral Pain Syndrome Treatment

At the first sign of pain, cut back your mileage. The sooner you lessen the knee’s workload, the faster healing of runner’s knee begins. Outside of running, avoid knee-bending activities, slanted surfaces, and downward stairs and slopes until the pain subsides.

As you rebuild mileage, use a smaller stride on hills and ice your knee for about 15 minutes after each run, Metzl says. He also recommends considering orthotics if new shoes don’t fix the problem, and seeing a doctor if the pain persists to rule out another condition.

Patellofemoral Pain Syndrome Prevention

To prevent PFPS, run on softer surfaces when possible, keep mileage increases to less than 10 percent per week, and gradually increase hill work in your program.

In the gym, strengthening your quadriceps will improve patellar tracking, according to William O. Roberts, M.D., professor of family medicine and community health at the University of Minnesota.

“When properly aligned, [the patella] slides in a groove on the end of the femur as the knee bends,” he says. “A good analogy to explain this is of a train car: The patella is like a train on the femoral groove railroad track.”

Metzl also recommends strengthening your lower body with plyometric jump squats, and foam rolling your quadriceps and IT bands. Visiting a specialty running shop to make sure you’re wearing the proper shoes for your foot type and gait is also a good idea.

Laura Peill is a nutritionist, long distance runner, and clinical Pilates teacher.